[Novel European Heart Failure Guidelines - Change in Treatment Paradigms]

NEW DRUG THERAPY ALGORITHM FOR HEART FAILURE WITH LVEF ≤ 40 %:  The new Heart Failure Guidelines 2021 recommend a fundamentally new treatment algorithm for heart failure (HF) with reduced ejection fraction ≤ 40 % (HFrEF). This involves, that all four mortality reducing substances (ARNI or ACE-Inhibitor, Betablocker, MRA und SGLT-2-Inhibitor) are given as fast as possible. The conventional sequence with stepwise uptitration is no longer recommended.

The diagnostic algorithm has been simplified for HFpEF, which requires not only signs and symptoms of HF, but also a LVEF ≥ 50 % and additionally objective criteria for a structural and/or functional abnormalities with diastolic dysfunction, elevated filling pressures and elevated natriuretic peptides. Etiology of HFpEF should be evaluated. There is no change in the treatment recommendations of HFpEF in contrast to 2016, but a short-term revision of the guidelines can be expected.

The primary recommendation for atrial fibrillation is anticoagulation with NOAKs. The value of PVI has been upgraded. The decision for transcatheter therapy of secondary mitral regurgitation should be made in the heart team if appropriate criteria are present.

For the diagnosis of advanced heart failure four key criteria were defined, including severe and persistent symptoms (NYHA III or IV), a severe cardiac dysfunction, episodes of congestion treated with i. v. diuretics and/or inotropes, malignant arrhythmias and a severe impairment of exercise capacity. There is a new treatment algorithm for these patients, in which the importance of mechanical support was upgraded.

For patients with acute heart failure, integration into a disease management program and a multimodal, multiprofessional therapy concept is recommended after discharge from inpatient treatment.